Interrupting transmission of soil-transmitted helminths: cluster randomised trial evaluating alternative treatment strategies in Kenya

据估计，全世界约有14.5亿人感染肠道蠕虫，也称为土壤传播蠕虫（STH）。慢性和严重的性病感染可导致营养不良和缺铁性贫血，也可对儿童的身心发育产生不利影响。在全球范围内，STH导致每年有498万人生活在残疾中。然而，幸运的是，国际社会越来越致力于解决这些感染问题，许多国家现在成功地实施了有地域针对性的方案，通过学校为学龄儿童提供大规模治疗。然而，虽然以学校为基础的驱虫对接受治疗的儿童有许多重要的好处，但最近的数学模型表明，仅治疗学龄儿童很少能阻止这些寄生虫的传播，除非在传播率很低的环境中，因此需要采取替代治疗方法，包括扩大治疗范围和频率。为了有效地提供这种扩大的治疗，有一个相关的需要，以评估使用社区卫生工作者治疗成人人口的影响和成本效益。我们计划评估学校与社区为基础的治疗在减少性病传播方面的影响。一系列定量和定性评估将评价不同战略和执行系统的成本、成本效益、可接受性和可行性。这项研究将在肯尼亚两个截然不同的环境中进行-南部沿海和西部地区-估计有20%的人口感染性病。为了最大限度地提高公共卫生相关性，这项研究将纳入正在进行的全国学校驱虫方案，该方案目前每年治疗460万学龄前儿童和在校儿童。研究药物将由葛兰素史克捐赠，通过学校和社区提供的全部费用将由儿童投资基金基金会承担，肯尼亚政府提供额外投入。比尔和梅林达·盖茨基金会已经为一些试验活动提供了共同资金。开展这项研究的兴趣很大。肯尼亚政府、其他国家政府、资助者和国际决策者正在寻求明确的政策和技术指导，以确定阻断性病传播的最佳方法。与此同时，各国越来越多地利用社区卫生工作者（社区卫生工作者;向社区提供基本保健和医疗服务的社区成员，通常是志愿者）提供广泛的卫生干预措施，因此有必要评估利用社区卫生工作者提供性传播疾病治疗的好处。拟议的研究是非洲的第一项此类研究，将解决这些政策信息差距问题。我们提议的研究是在国家一级以需求为导向的，肯尼亚的合作伙伴支持交付，并致力于扩大新战略，一旦证明是有益的。这些发现不仅将为肯尼亚和其他性病流行国家的政策和实践提供信息，还可能导致世卫组织关于性病社区控制的新指南，并最终为受性病影响的贫困社区带来明显的好处。

Some 1.45 billion people are estimated to be infected worldwide with intestinal worms, also known as soil-transmitted helminths (STH). Chronic and intense STH infections can contribute to malnutrition and iron-deficiency anaemia, and also can adversely affect physical and mental growth in childhood. Globally, STH result in 4.98 million years lived with disability each year. Fortunately, however, the global community is increasingly committed to tackling these infections, with many countries now successfully implementing geographically-targeted programmes that provide mass treatment to school-aged children delivered through schools. However, whilst school-based deworming has many important benefits for treated children, recent mathematical modelling suggests that treating only school-aged children will rarely stop transmission of these parasites, except in very low transmission settings, and that alternative approaches to treatment, including extending coverage and frequency of treatment, are required. To effectively deliver such expanded treatment, there is an associated need to evaluate the impact and cost-effectiveness of using community health workers to treat adult populations. We plan to evaluate the impact of school- versus community-based treatment in reducing the transmission of STH species. A range of quantitative and qualitative assessments will evaluate the costs, cost-effectiveness, acceptability and feasibility of the different strategies and delivery systems. The study will be conducted in two contrasting settings in Kenya - south coastal and western regions - where an estimated 20% of the population are infected with STH. In order to maximize public health relevance, the study will be nested within the ongoing national school-based deworming programme, which is currently treating 4.6 million preschool and school children annually. The study drugs will be donated by GlaxoSmithKline and the full costs of delivery through schools and communities will be covered by the Children's Investment Fund Foundation, with additional input from the Government of Kenya. Cofunding for some of the trial activities are already funded by the Bill & Melinda Gates Foundation. There is tremendous interest in conducting this study. The Government of Kenya, other national governments, funders and international policy makers are seeking clear policy and technical guidance as to the optimal approach to interrupt STH transmission. At the same time, countries are increasingly using community health workers (CHW; community members who provide basic health and medical care to their community, often on a volunteer basis) to deliver a wide range of health interventions, and there is a need to evaluate the benefits of using CHWs to deliver STH treatment. The proposed study, the first of its kind in Africa, will address these policy information gaps. Our proposed study is demand-led at the country level, with partners in Kenya supporting delivery and committed to scaling-up the new strategy, once demonstrated to be beneficial. Not only will the findings inform policy and practice in Kenya and other STH endemic countries, they may also lead to new WHO guidelines on the community control of STH and ultimately have demonstrable benefits for the impoverished communities affected by STH.